Li Zhixiong, Lin Qingshui, Lin Liangqing, Wu Qinghua, Ke Pinhui, Chen Huan, Lin Chunlan, Yu Yaohua
Department of Anesthesiology, The School of Clinical Medicine Fujian Medical University, The First Hospital of Putian, Putian, China.
Front Surg. 2023 Oct 24;10:1267477. doi: 10.3389/fsurg.2023.1267477. eCollection 2023.
Paravertebral block (PVB) has been increasingly popular for postoperative analgesia. However, few studies estimated the efficacy and safety of multiple PVB using thoracoscope-assisted technique for intraoperative analgesia and postoperative pain management for video-assisted thoracoscopic lobectomy (VATS LOBECTOMY).
A total of 120 patients scheduled to undergo VATS LOBECTOMY were randomly assigned into two groups: a placebo group and a PVB group in a ratio of 1:2. Thoracoscopic-guided multi-point PVB was carried out with 0.5% ropivacaine (PVB group) or 0.9% NaCl (placebo group) at the beginning and the end of surgery. The primary endpoint was consumption of intraoperative opioid.
Consumption rate of intraoperative opioids was significantly lower in the PVB group (878.14 ± 98.37 vs. 1,432.20 ± 383.53 for remifentanil; 123.83 ± 17.98 vs. 266.42 ± 41.97 for fentanyl). Postoperatively, significantly longer duration of using patient-controlled intravenous analgesia for the first time, reduced times of analgesic pump pressing, and less rescue analgetic consumption were observed in the PVB group. Visual analog scale scores at rest and during exercising were significantly lower in the PVB group at all time points within the first 48 h after surgery. The PVB group was also associated with significantly higher total QoR-40 scores and lower incidence of analgesia-related adverse events.
Thoracoscopic-guided multiple PVB was a simple and effective technique in controlling pain both intra- and postoperatively for VATS LOBECTOMY. It was also associated with the absence of detrimental effects attributed to opioid overuse and benefits of the early resumption of activity and physical function recovery. Therefore, this regional anesthesia technique should be advocated as part of a multimodal analgesia protocol for VATS LOBECTOMY.
椎旁阻滞（PVB）在术后镇痛中越来越受欢迎。然而，很少有研究评估使用胸腔镜辅助技术进行多次PVB用于电视辅助胸腔镜肺叶切除术（VATS肺叶切除术）术中镇痛和术后疼痛管理的有效性和安全性。
总共120例计划接受VATS肺叶切除术的患者被随机分为两组：安慰剂组和PVB组，比例为1:2。在手术开始和结束时，使用0.5%罗哌卡因（PVB组）或0.9%氯化钠（安慰剂组）进行胸腔镜引导下多点PVB。主要终点是术中阿片类药物的消耗量。
PVB组术中阿片类药物的消耗率显著更低（瑞芬太尼：878.14±98.37 vs. 1432.20±383.53；芬太尼：123.83±17.98 vs. 266.42±41.97）。术后，PVB组首次使用患者自控静脉镇痛的持续时间显著更长，镇痛泵按压次数减少，急救镇痛药物消耗量更少。在术后48小时内的所有时间点，PVB组静息和运动时的视觉模拟量表评分均显著更低。PVB组的QoR-40总分也显著更高，镇痛相关不良事件的发生率更低。
胸腔镜引导下多次PVB是一种简单有效的技术，可用于控制VATS肺叶切除术的术中及术后疼痛。它还与避免阿片类药物过度使用的有害影响以及早期恢复活动和身体功能恢复的益处相关。因此，应提倡将这种区域麻醉技术作为VATS肺叶切除术多模式镇痛方案的一部分。
